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Webinar: Meaningful Use Implications for Small Community and Critical Access Hospitals

Join our webinar to learn about the implications of meaningful use for small community and critical access hospitals. Our speaker will discuss HIT stimulus payments, EHR technology, and more.

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Webinar: Meaningful Use Implications for Small Community and Critical Access Hospitals

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  1. Today’s Webinar: Meaningful Use Implications for Small Community and Critical Access Hospitals Audio1-866-699-3239Access Code: 829 093 050 champions for small community hospitals

  2. Today’s Webinar: Meaningful Use Implications for Small Community and Critical Access Hospitals • All lines are muted • Please enter any questions in the chat log • Questions will be addressed at the end of the presentation

  3. Introduction to Healthland • Healthland is focused – 100% – on delivering fully integrated technology solutions to rural hospitals • Healthland EHR technology will: • Help you deliver exceptional patient care • Achieve ‘meaningful use’ • Qualify for incentive payments

  4. Today’s Speaker:Ralph J. Llewellyn, CPA, CHFPPartner – Eide Bailly

  5. Agenda • Health Information Technology (HIT) Stimulus Payments • Critical Access Hospitals • Prospective Payer Hospitals • Physician Practices

  6. HIT Stimulus Payments • Proposed rule released with 60 day comment period • Meaningful use defined • Process for payment defined • Payments for meaningful use of certified EHR technology

  7. HIT Stimulus Payments • Defined: • Fiscal Year – year beginning on October 1 and ending September 30 • EHR reporting period • 1st year – Continuous 90 day period within first payment year • Subsequent – Entire payment year

  8. HIT Stimulus Payments

  9. HIT Stimulus Payments • Demonstration of Meaningful Use • One time attestation following completion of EHR reporting period for a given payment year • Identify certified EHR utilized • Identify results of their performance on all measures

  10. Stimulus Payments – Medicare Share • Medicare Share • Based on inpatient volume • Numerator • Medicare days + Medicare Advantage patient days • IP, intensive care, Pysch, Rehab, Sub-acute • Excludes SB • Denominator • Total inpatient days TIMES • Hospital charges less charity care DIVIDED BY hospital charges • No provision for carve outs

  11. Stimulus Payments – Medicare Share • Charity Care • As identified on Worksheet S-10 Line 19 of the Medicare cost report for PPS Hospitals • Indigent Care Medicare Bad Debt? • Not reported on Medicare Cost Report for CAH’s • May be coming in the future?

  12. Stimulus Payments – Hospital (CAH) • Payments available 2011 – 2015 • Fiscal year after FY 2010, but before FY 2016 • Example – If December 31st year end, first year begins January 1, 2011. • No payments after 2015 • Up to 4 consecutive payment years

  13. Stimulus Payments – Hospital (CAH) • Allowed to expense their costs associated with the purchase of certified EHR technology in a single year • Versus depreciating these costs on the cost report • Current year and prior year purchases (undepreciated value) • Potential deferred revenue issues? • Reimbursement based on Medicare Share + 20 percentage points (not to exceed 100%) • Lump sum prompt payment subject to reconciliation

  14. Stimulus Payments – Hospital (CAH) • Allowable Expense • Reasonable cost – “computers and associated hardware and software necessary to administer EHR technology” • EHR technology – “electronic record of health related information on an individual that includes patient demographic and clinical health information and has the capacity to • (1) provide clinical decision support, • (2) support physician order entry, • (3) capture and query information relevant to health care quality • (4) to exchange electronic health information with, and integrate such information from other sources”

  15. Stimulus Payments – Hospital (CAH) • Allowable Expense • Incentive payment in lieu of depreciation AND interest? • “Be smart about your interest” • MAC/FI to review cost reports to ensure the assets associated with the acquisition of certified EHR technology are expensed in a single period and that depreciation and interest expenses associated with the acquisition are not allowed • Subject to reconciliation

  16. Stimulus Payments – Hospital (CAH) • Failure to become a meaningful EHR user by FFY 2015 • Reduction in 101% of cost • FFY 2015 – 100.66% of cost • FFY 2016 – 100.33% of cost • FFY 2017 – 100.00% of cost

  17. Stimulus Payments – Hospital (CAH) • Strategy • Place EHR assets in use and become meaningful user in same fiscal year

  18. CAH Payment Calculation Example

  19. Stimulus Payments – Hospital (PPS) • Does not include Puerto Rico, psychiatric, rehabilitation, long term care, children’s or cancer hospitals. • Payment based on the following • Initial Amount • Medicare Share • Transition Factor

  20. Stimulus Payments – Hospital (PPS) • Initial Amount • Base payment for each PPS hospital = $2,000,000 • Adjusted for discharges 1,150 to 23,000 • $200 additional per discharge in this range • Times your Medicare Share (same calculation as CAH)

  21. Stimulus Payments – Hospital (PPS) • Preliminary payment • Hospital discharge data from the hospital FY prior to the FY that serves as the payment year • Settled on the cost report that ends during the payment year

  22. Stimulus Payments – Hospital (PPS) • Transition Factor (FFY 2011 – 2013) • Year 1 = 1 • Year 2 = ¾ • Year 3 = ½ • Year 4 = ¼ • Subsequent Years = 0 • Transition Factor (FFY 2014 – 2015) • If the facility’s first year of eligibility is after FFY 2013, the transition factor is the same as a facility with a first payment in FFY 2013 • If the first payment year is after FFY 2015, the transition factor

  23. Stimulus Payments – Hospital (PPS)

  24. Stimulus Payments – Hospital (PPS) • Failure to become a meaningful EHR user by FFY 2015 • Market Basket Adjustments reduction on ¾ of adjustment • FFY 2015 – 33 1/3 percent • FFY 2016 – 66 2/3 percent • FFY 2017 – 100 percent • Net Impact • FFY 2015 – 25 percent • FFY 2016 – 50 percent • FFY 2017 – 75 percent

  25. PPS Payment Calculation Example

  26. PPS Payment Calculation Example

  27. Stimulus Payments – Physician • Physician defined • Doctor of Medicine • Doctor of Osteopathy • Doctor of Dental Surgery • Doctor of Podiatric Medicine • Doctor of Optometry • Chiropractor

  28. Stimulus Payments – Physician • Payment Year and Year of Payment defined • Any calendar year beginning with 2011 • Incentive • 75% of Secretary’s estimate of allowed charges for covered services furnished by eligible professional during relevant payment year. • Paid claims no later than 2 months after relevant year • Up to 5 years • No incentive after 2016

  29. Stimulus Payments – Physician • Incentives do not apply to: • Provider based physicians • Substantially all professional services provided in hospital setting • 90% of services • Place of Service 21 – Inpatient • Place of Service 22 – Outpatient • Place of Service 23 – Emergency Room

  30. Stimulus Payments – Physician • Incentives do not apply to: • RHCs/FQHCs • May qualify for Medicaid incentive if >30% of patients considered “needy” • Receiving medical assistance from Medicaid or CHIP • Furnished uncompensated care by provider • Furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay

  31. Stimulus Payments – Physician

  32. Stimulus Payments – Physician • HPSA Incentive • 10% increase in incentive • Provides services predominately in HPSA • Defined as greater than 50% • January 1 – December 31 frequency • If HPSA by December 31 of prior year • No impact if HPSA lost during current year • No impact if HPSA obtained during current year

  33. Stimulus Payments – Physician

  34. Stimulus Payments – Physician • Single Consolidated Payment • Ascertain professional has demonstrated meaningful use • Reaches maximum payment limit • If maximum payment limit is not reached payment is processed 2 months after relevant payment year • Multiple Employers/Contractual Arrangements • Assign incentive to 1 employer or entity

  35. Stimulus Payments – Physician • Failure to become a meaningful EHR user by 2015 • 2015 – 99% of applicable fee schedule • 2016 – 98% of applicable fee schedule • 2017 – 97% of applicable fee schedule • 2018 – Additional 1% reduction if less than 75% professionals are meaningful users. Subsequent year reductions capped at 95%

  36. Summary • The financial impact to your facility will be dependent on the timing of implementation and the type of licensing. • Monitoring changes in the final rule.

  37. Questions?

  38. Healthlandinfo@healthland.com800.323.6987 EideBailly Ralph Llewellyn rllewellyn@eidebailly.com 701.239.8594 www.healthland.com/stimulus

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